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Risk of Autism Associated With Hyperbilirubinemia and Phototherapy

Yvonne W Wu1,2,3, Michael W Kuzniewicz2,3, Lisa Croen3

  • 1Departments of Neurology, wuy@ucsf.edu.

Pediatrics
|September 28, 2016
PubMed

Insights

Neonatal hyperbilirubinemia and phototherapy do not increase the risk of autism spectrum disorder (ASD). This large study found no significant association after accounting for other factors, suggesting these conditions are not independent risk factors for ASD.

Area of Science:

  • Neonatal care
  • Neurodevelopmental disorders
  • Pediatric health

Background:

  • Neonatal hyperbilirubinemia is common, and phototherapy is a standard treatment.
  • The potential link between neonatal jaundice, its treatment, and autism spectrum disorder (ASD) requires clarification.
  • Previous studies have yielded conflicting results regarding this association.

Purpose of the Study:

  • To investigate the association between elevated total serum bilirubin (TSB) levels in neonates and the risk of developing ASD.
  • To determine if phototherapy for neonatal jaundice is associated with an increased risk of ASD.
  • To quantify the risk of ASD in relation to hyperbilirubinemia and phototherapy, adjusting for confounding variables.

Main Methods:

  • A retrospective cohort study was conducted on 525,409 infants born at ≥35 weeks' gestation.
  • Data on total serum bilirubin (TSB) levels and phototherapy use were collected from Kaiser Permanente Northern California hospitals (1995-2011).
  • Autism spectrum disorder (ASD) diagnoses were identified from the Kaiser Permanente Northern California Autism Registry; Cox proportional hazard ratios were calculated.

Main Results:

  • Crude analyses indicated a potential association between TSB levels ≥20 mg/dL and phototherapy with ASD.
  • However, after adjusting for confounding factors such as sociodemographic variables and birth weight, these associations were no longer statistically significant.
  • Independent risk factors for ASD included parental age, parental education, male sex, extreme birth weights, and year of birth.

Conclusions:

  • Neither neonatal hyperbilirubinemia (elevated TSB) nor the use of phototherapy were found to be independent risk factors for autism spectrum disorder (ASD).
  • The study highlights the importance of adjusting for confounding factors in research on neonatal conditions and neurodevelopmental outcomes.
  • Findings suggest that common neonatal jaundice management strategies do not contribute to ASD risk.
Abstract

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